Preparing to die

Friday, October 31, 2003

The legal and moral issues surrounding the case of a Florida woman whose life depends on artificial support are complex. If anything good can come from the ongoing wrangling between those who believe it is time to let her die and those who believe her life must be maintained at all costs, it is an awareness that careful planning and preparation might avoid a similarly sticky situation for millions of families.

Terri Schiavo has been in a persistent vegetative state since 1990, according to her doctors. Her husband, Michael Schiavo, says his wife told him she would rather die than be kept alive artificially. Her parents, however, say they never heard their daughter say anything like that.

Among the many legal issues is the question of who has authority to make a decision to prolong someone's life in situations like this. In Florida, the law is fairly straightforward: A spouse has that right. Others who can make such decisions, depending on circumstances, are children and parents. The legal system in Florida acceded to Michael Schiavo's wishes to take his wife off life-support systems and let her die. The Florida Legislature quickly passed an emergency law to keep her alive, as the woman's parents wished. Gov. Jeb Bush signed the law.

The debate over this case and the subsequent legal and legislative maneuvers have grown more vocal along each step of the process. While many similar cases never receive the worldwide publicity the Schiavo case has generated, there are countless cases where family members are asked to make end-of-life decisions.

Even the American Bar Association concedes that having a health-care advance directive such as a living will or durable power of attorney for health care won't always guarantee that an individual's own wishes will be carried out.

Indeed, the ABA says, "Studies have shown that standard advance-directive forms do little to influence end-of-life decisions without (1) informed, thoughtful reflection about your wishes and values and (2) personal communication between you and your likely decision-makers before a crisis occurs."

A living will is a document that details the care you expect to receive in a life-or-death situation. A durable power of attorney for health care entrusts those decisions to someone you want to carry out your wishes.

The ABA's words of caution cannot be taken lightly. Even when you take the appropriate legal steps to prepare for end-of-life decisions, you must make sure you thoroughly discuss your wishes with those who will have to deal with doctors and hospitals in these circumstances.

An Internet search of topics such as "living wills" and "health care advance directive" will turn up dozens of Web sites with information. One such site is the ABA Commission on Law and Aging site: www.abanet.org/aging/toolkit/.